News from your heart

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CLEVELAND, Ohio (Ivanhoe Newswire) – Every 33 seconds, someone in the U.S. dies from heart disease. That’s roughly the equivalent of a September 11th –like tragedy repeating itself every 24 hours, 365 days a year. Now, researchers are learning more about what puts you at risk.

About 80 million Americans are living with it and one million Americans die from heart disease each year. Cleveland Clinic Dr. Stanley Hazen is learning more about what puts you at risk.

“If it’s not your genes, it’s your environment and our biggest environment exposure is what we eat,” Stanley L. Hazen, MD, PhD, Cardiologist and Vice Chair of Research, Cleveland Clinic's Lerner Research Institute, told Ivanhoe.

In a clinical study, Hazen and his team discovered that people who have more of a compound called TMAO in their blood are two-and-a-half times more likely to experience heart attack, stroke, or death.

“TMAO just stuck out like sore thumb as being highly correlated with future event risk,” Dr. Hazen said.

TMAO is produced when intestinal bacteria digest nutrients found in certain foods like meat. Hazen believes avoiding those foods and upping fiber intake can offset this link over time.

Hazen also found HDL cholesterol – often referred to as the “good cholesterol” –may not be so good after all.

“Simply measuring how much cholesterol is in the HDL particle does not give us a good reflection of its role in protecting from heart disease,” Dr. Hazen explained.

The study showed dysfunctional HDL cholesterol in the artery wall actually contributed to heart disease.

“It’s the function of the particle that seems to be more important,” Dr. Hazen said.

Two new insights that could help researchers develop treatments for the number one killer in our country.

Dr. Hazen says there will likely be a TMAO blood test available in clinics around the country this year. He says identifying this compound is the first step. The next is to develop therapies to stop it – which may stop heart disease from forming.

BACKGROUND: Heart disease is the number one killer of both men and women in the United States and has become one of the most serious public health issues facing Americans. It is a broad term which refers to a variety of related heart conditions, including heart attack, ischemic stroke, and heart failure. The disease kills 600,000 people each year, which is about one out of every four deaths. (Source:

TMAO: TMAO is a microbial byproduct of intestinal bacteria that contributes to heart disease and serves as an accurate screening tool for predicting future risks of stroke, heart attack, and death in people not otherwise identified by traditional risk factors and blood tests, according to researchers at the Cleveland Clinic. The current study is an extension of Dr. Stanley Hazen’s previous work that found TMAO is produced when intestinal bacteria digest the nutrient phosphatidylcholine, commonly known as lecithin. The previous research showed that TMAO levels in the blood were associated with heart disease. They now have confirmed that gut flora are essential in forming TMAO and demonstrated a relationship between TMAO levels and future cardiac events like heart attack, or stroke. Researchers then found that the higher TMAO blood levels were associated with higher future risks of death and nonfatal heart attack or stroke. "Heart disease remains the number one killer, and while we know how to reduce cholesterol, treat blood pressure, and reduce cardiac risks through diet and other interventions, a substantial residual risk still remains," Dr. Hazen was quoted as saying. "We need to find new pathways to attack heart disease, and these findings strongly suggest that further research into the involvement of gut microbiome in the development of cardiovascular disease could lead to new avenues of prevention and treatment of heart disease." (Source:

HDL CHOLESTEROL: About one-fourth to one-third of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as “good cholesterol” because levels of HDL seem to protect against heart attack. Low levels of HDL, which is less than 40 mg/dL for men and less than 50 mg/dL for women, also increase the risk of heart disease. Medical experts think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. However, Dr. Hazen found that dysfunctional HDL not only no longer does its normal job of clearing plaque, it actually makes them worse by causing inflammation in the vessel walls, and may help explain why drug treatments that boost HDL levels have failed to improve heart disease outcomes. Dr. Hazen says they are close to a blood test that will allow doctors to detect the dysfunctional form of the cholesterol carrier in the blood. “It’s not only a new diagnostic test but it’s also a potentially new target for the treatment of heart disease, because the dysfunctional HDL is an active pro-inflammatory player now that we see in the disease process,” Dr. Hazen was quoted as saying. (Source: